ACCESS TO SAFE ABORTION IN ASIA AND THE PACIFIC REGION Sivananthi Thanenthiran 2019 • ISBN 978-967-0339-50-4 This work is licensed under the Creative Commons Attribution-Non- Commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/. ABOUT THIS BRIEF Any part of the text of the publication may be photocopied, This brief is part of ARROW’s State of the Region Report on Sexual and reproduced, stored in a retrieval system, or transmitted in any form Reproductive Health and Rights: International Conference on Population by any means, or adapted and translated to meet local needs, for and Development (ICPD+25), developed as a result of monitoring of 25 non-commercial and non-profit purposes. However, the copyright years of implementing the ICPD programme of Action in the region by for images used remains with respective copyright holders. All ARROW and our partners. This is the fifth five-yearly review, research forms of copies, reproductions, adaptations, and translations and monitoring report contributing to insights on progress, gaps and through mechanical, electrical, or electronic means should challenges to ICPD PoA implementation in the region. This brief provides acknowledge ARROW as the source. A copy of the reproduction, an overview of the status of SRHR in Asia and the Pacific region with adaptation, and/or translation should be sent to ARROW. In cases a focus on 19 countries. The monitoring series also includes country of commercial usage, ARROW must be contacted for permission at level research findings around the status of ICPD implementation in 13 [email protected]. countries in the region. ASIAN-PACIFIC RESOURCE & RESEARCH CENTRE FOR WOMEN (ARROW) 1 & 2 Jalan Scott, Brickfields, Kuala Lumpur, Malaysia 50470 Telephone (603) 2273 9913/9914/9915 Fax (603) 2273 9916 E-mail [email protected] Web www.arrow.org.my Facebook https://www.facebook.com/ARROW.Women Twitter @ARROW_Women COUNTRY CASE STUDIES Youtube youtube.com/user/ARROWomen Pinterest arrowomen Bangladesh: Tasnim Azim, Samia Afrin, Md. Nashir Uddin, Altaf Hossain, Jamil Hussain Chowdhury, Naripokkho, Association for Prevention of Septic Abortion, Bangladesh (BAPSA) Cambodia: Reproductive Health Association of Cambodia PRODUCTION TEAM (RHAC) Author: Sivananthi Thanenthiran India: TK Sundari Ravindran, P. Balasubramanian, Padma Project Coordinators: Sivananthi Thanenthiran, Bhate-Deosthali, CommonHealth Sai Jyothirmai Racherla, Nepal: Dr. Laxmi Tamang, Shanta Laxmi Shrestha, Radhika and Shamala Chandrasekaran Ghimire, Aliza Singh, Beyond Beijing Committee Copy Editor: Charity Yang (BBC) Graphic Design: Nicolette Mallari Philippines: Christelyn Sibugon, Marevic Parcon, Women’s Global Photo Credits: Michal Knitl/Shutterstock.com Network for Reproductive Rights (WGNRR) Sivananthi Thanenthiran Asian-Pacific Resource & Research Centre for Women Introduction to Abortion and Safe Abortion and Human References to POA Rights Framework Safe abortion is a necessary component of reproductive In 1995, in Beijing, the women’s movement was able to health services, though some parties continue to take it one step further in the Beijing Platform for Action, contest the issue. In the ICPD, Paragraph 8.25 speaks in which Paragraph 107 (j) and (k) adopted Paragraph of the need to reduce the recourse to abortion through 8.25 in full, with the addition of “consider[ing] reviewing contraception; pre-and-post abortion counselling; where laws containing punitive measures against women who abortion is not against the law, such abortion should be have undergone illegal abortions.” This helped mitigate safe; and that at the very least, all countries should have the caveat that abortion should be primarily viewed 4 access to services for the management of complications within the existing legal frameworks of countries, and arising from abortion. that there was an onus on States to review and change Access to Safe laws on abortion. This shift also helped position abortion Abortion in Asia and the Pacific As the ICPD PoA was negotiated between countries, not only as a public health issue but also one of women’s Region some compromises with regards to abortion appear rights: because only women need abortions, legislation within the ICPD PoA itself. The compromises can be that limits or makes abortion inaccessible harms women located in the following paragraphs on abortion: and is construed as gender discrimination. • 7.24 which does not recognise the role of abortion in This legal shift also enabled further work on abortion as limiting births; a human rights issue. • 7.6 which limits service provision to the prevention and management of abortion complications; The CEDAW committee noted that: “Unsafe abortion is • 8.19 which discusses abortion prevention but not the a leading cause of maternal mortality and morbidity. As provision of safe abortion services; such, States parties should legalize abortion at least in • 8.22 which again only considers service provision to cases of rape, incest, threats to the life and/or health treat abortion complications. of the mother, or severe foetal impairment, as well as provide women with access to quality post-abortion care, All of these compromises, in 1994, led to safe abortion especially in cases of complications resulting from unsafe being caveated at different policy levels, and led to abortions. States parties should also remove punitive limited access for women. These compromises continue measures for women who undergo abortion.”2 to haunt us in all inter-governmental negotiations till today. Furthermore, General Recommendation 35 by the CEDAW committee frames a denial of safe abortion The U.S government in particular has affected the way services as a form of gender-based violence in paragraph in which abortion issues continue to be politicised 18: “Violations of women’s sexual and reproductive outside of the United States. Since 1994, women’s health and rights, such as forced sterilization, forced health and safety has been compromised through the abortion, forced pregnancy, criminalization of abortion, different enactments of the Global Gag Rule, from the denial or delay of safe abortion and/or post-abortion periods 2001-2009, and again 2017 till the present day. care, forced continuation of pregnancy, and abuse and The most recent Global Gag Rule of the Trump-Pence mistreatment of women and girls seeking sexual and administration affects not only family planning clinics reproductive health information, goods and services, are but all organisations which receive any US government forms of gender-based violence that, depending on the funding from its global health budget. The global gag circumstances, may amount to torture or cruel, inhuman rule has devastating consequences on women’s lives as or degrading treatment.”3 evidence notes: there was symmetric reduction in use of modern contraception, increase in pregnancies, and a The Committee on Economic, Social and Cultural Rights rise in abortion rates.1 noted in its General Comment 22 that: “The realization of the rights of women and gender equality, both in law and in practice, requires repealing or reforming discriminatory laws, policies and practices in the area of Reclaiming & Redefining Rights ICPD+25: Status of SRHR in Asia and the Pacific Region sexual and reproductive health. Removal of all barriers What is a common thread in the deliberations of all the interfering with access by women to comprehensive different committees is that governments are called to sexual and reproductive health services, goods, legalise abortion in specific circumstances, decriminalise education and information is required. To lower rates of in all cases, and guarantee access to safe abortion maternal mortality and morbidity requires emergency services for all women and girls. obstetric care and skilled birth attendance, including in rural and remote areas, and prevention of unsafe The work of the Committee against Torture also framed a abortions. Preventing unintended pregnancies and denial of abortion services as a form of torture, and this unsafe abortions requires States to adopt legal and is noted in the reviews and recommendations at country policy measures to guarantee all individuals access level with a particular emphasis on Latin-American to affordable, safe and effective contraceptives and countries. 5 comprehensive sexuality education, including for adolescents; to liberalize restrictive abortion laws; to The UN Committee against Torture also saw the denial of guarantee women and girls access to safe abortion abortion services as a form of torture. In 2006 and 2012, Access to Safe Abortion in Asia services and quality post-abortion care, including by when reviewing Peru, the Committee noted the case and the Pacific training health care providers; and to respect the right of of LC vs Peru, and that Peru’s restrictive abortion law Region women to make autonomous decisions about their sexual leads to “grave consequences, including the unnecessary and reproductive health.”4 deaths of women.” The Committee also called upon Peru to “take whatever legal and other measures … necessary to effectively prevent acts that put women’s health at However, despite the work at the global grave risk, by providing the required medical treatment.” level, there has been a gap in establishing In 2011, when reviewing Paraguay, the Committee against reproductive rights, in particular, the Torture strongly noted the long-standing psychological consequences